In patients with MINOCA, late gadolinium enhancement (HR 1.108) and myocardial perfusion reserve (HR 0.062) independently predicted the risk of major adverse cardiovascular events.
Cohort (n=279)
No
Does stress cardiac MRI (LGE and MPR) predict major adverse cardiovascular events in patients with MINOCA?
Stress cardiac MRI parameters, specifically LGE and MPR, independently predict MACE risk in MINOCA patients, offering incremental prognostic value.
Effect estimate: HR 0.062 (95% CI 0.007-0.524)
p-value: p=0.011
Abstract Objectives To evaluate the prognostic value of stress cardiac MRI in myocardial infarction with nonobstructive coronary arteries (MINOCA), and to investigate its efficacy in risk stratification. Materials and methods A total of 279 MINOCA patients undergoing stress cardiac MRI were retrospectively enrolled. Patients were classified into 4 subgroups according to the cardiac MRI phenotype: (1) presence of late gadolinium enhancement (LGE) and inducible ischemia+ ( n = 95); (2) LGE+/inducible ischemia− ( n = 72); (3) LGE–/inducible ischemia+ ( n = 69); and (4) LGE–/inducible ischemia− ( n = 43). The primary outcome was major adverse cardiovascular events (MACE). Results Over a median follow-up of 41 months, MACE occurred in 11.5% of patients. Those who developed MACE showed significantly reduced cardiac function (left ventricular ejection fraction (LVEF): 38.6 35.2; 51.6 vs 54.5 48.7; 61.6, p < 0.001), severe microvascular dysfunction (myocardial perfusion reserve (MPR): 1.5 1.4; 1.7 vs 1.9 1.8; 2.6, p < 0.001), and extensive myocardial damage (LGE: 9.6 7.7; 25.6 vs 2.4 0.0; 6.2, p < 0.001). Multivariate Cox regression showed that LGE (HR: 1.108, 95% CI: 1.047–1.172, p < 0.001) and MPR (HR: 0.062, 95% CI: 0.007–0.524, p = 0.011) were independently associated with MACE. Kaplan–Meier analysis indicated that patients with LGE ≥ 8.39 and MPR < 1.75 had a significantly higher MACE risk ( p < 0.001). Conclusion In MINOCA patients, LGE and MPR independently predict MACE risk. Particularly, MPR offers incremental prognostic value by further stratifying patients with limited LGE. Critical relevance statement MINOCA is a clinically important and heterogeneous entity, often associated with adverse long-term outcomes. Stress cardiac MRI parameters, LGE and MPR, can predict the prognosis of patients with MINOCA, facilitating risk stratification and guiding subsequent management decisions. Key Points Stratifying MINOCA patients into subgroups based on cardiac MRI tissue and functional characteristics enables refined risk stratification. In MINOCA patients with limited LGE, impaired MPR is associated with a higher incidence of MACE. Microvascular dysfunction may be recognized as one of the potential mechanisms contributing to MINOCA and is associated with adverse cardiovascular outcomes.
Tang et al. (Fri,) conducted a cohort in Myocardial infarction with nonobstructive coronary arteries (MINOCA) (n=279). Stress cardiac MRI (Late gadolinium enhancement and myocardial perfusion reserve) was evaluated on Major adverse cardiovascular events (MACE) (HR 0.062, 95% CI 0.007-0.524, p=0.011). In patients with MINOCA, late gadolinium enhancement (HR 1.108) and myocardial perfusion reserve (HR 0.062) independently predicted the risk of major adverse cardiovascular events.